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Depression and Anti-depressant Information
TSR Wiki > Life > Health and Relationships > Mental Health > Depression
Please note that all advice here is unprofessional and DEFINITELY should not replace advice from your doctor or pharmacist.
Depression is a very common feeling which will affect virtually all of us in our lifetime. Depression is treatable, and in this thread there will be information on 'talking treatments' and certain common anti-depressant drugs. Don’t worry if your prescription isn’t on the list. As you can appreciate it there is so much information to write down. If something is missed or if the is some information on a treatment excluded, feel free to add it in.
Antidepressant medication is usually prescribed for moderate to severe cases of depression, or milder depression in adults if it is their treatment of choice. Some antidepressants are also commonly prescribed for other disorders, such as anxiety disorders, PMDD, eating disorders and also non-psychiatric complaints.
What is depression?
For more information on depression, see the Depression article.
Read on for information on medication.
It is important to realise that depression is often caused by social conditions. That is, if you feel depressed, there are likely certain conditions in your life that are leading you to be depressed. Therefore, the most effective cure for depression is to change those conditions which led you to become depressed in the first place. Nevertheless, in some instances, depression has no outward cause however in both situations medication may be prescribed. Such medication may be effective, but this will vary according to the type of medication prescribed. Sometimes one medication may not work but this does not mean that another will not. Doctors will sometimes try you on one anti-depressant at first and change it if it is not working. However before attempting medication, it is advisable to seek other help methods such as councilling. Anti depressants should only be taken if you are aware of the risks and should not be relied on as a permanent solution.
SSRIs
SSRI stands for Selective Serotonin Re-uptake Inhibitors. Serotonin is a chemical in the brain, and decreased levels of it are believed to cause depression in some people. They have fewer side effects than some other classes of anti-depressant medication. They are the most common first line of treatment for depression, particularly in young people. It is likely that your GP or psychiatrist will prescribe them for you before trying other kinds of anti-depressant.
As the SSRIs all have a very similar mechanism of action, the side effects tend to be quite similar. You shouldn't worry if you have a lot of side effects in the first few weeks of taking one of these medications, as they will tend to get better as you continue to take the drug. Common side effects include: indigestion or nausea (which can normally be helped by taking the tablet with food), loss of appetite, loss of libido, dry mouth.
Types of SSRI:
Citalopram (Celexa, Cipramil)
Doses tend to be about 20mg a day but can be higher (up to 40mg) for severe cases. It can also be used for anxiety and body dysmorphia. It does have side effects, but these are quite rare - sweating, hallucinations, sleep disturbance, nausea etc. It does cause some dizziness when taken but this is fairly mild and generally accompanies the natural mood boost created by the increase of free seratonin levels to stimulate nerve cells. Its one of the more commonly prescribed medications when dealing with depression.
Recent guidance to GP's states that the dose should not be upped above 40mg.
Fluoxetine (Prozac)
Fluoxetine has the active ingredient fluoxetine hydrochloride. This is often prescribed to under 18's as a first choice, it will usually start at low doses e.g 10/15 mg then be built up if the patient feels it has effect. For mental health issues such as bulimia it will be given at 60mg usually but is very case dependant and will generally start at a low dosage. The maximum dosage is 80mg per day. Generally it takes a few days- weeks to take efffect and this is also the case for when you stop taking the medication. Occasionally symptoms of depression will increase until the medication has started to take effect, other reported side effects include anxiety and nervousness, drowsiness, inmsomnia, dizziness, fatigue, weight loss, tremor and increased sweating. All reported side effects are listed with the medication.
Escitalopram (Lexapro, Cipralex)
This is a relatively new SSRI and so is not usually prescribed for those deemed to be in development, such as the majority of under-18s. It's quite a popular SSRI because of its minimal associated weight gain and because it doesn't cause too much fatigue. In most cases it's deemed as pretty effective, and is also one of the main choices when depression is present alongside personality disorders such as Social Anxiety Disorder. In most cases 5mg is the advised dose for the first two weeks, and then doubled to 10mg thereafter. If personality disorders are seen as a contributary factor for the depression then a higher dose is usually needed, which tends to be 15mg, usually after a month of medication, and never above 20mg.
Fluvoxamine (Faverin)
Paroxetine (Seroxat)
Sertraline (Lustral, Zoloft)
SNRIs
SNRI stands for Serotonin and Noradrenaline Reuptake Inhibitor. These drugs work like SSRIs but slow the re-uptake of both 5-HT (serotonin) and noradrenaline, another neurotransmitter. Most Tri-Cyclic Antidepressants (TCAs; see below) function by the same pharmacological method, but SNRIs do so without some of the side-effects of TCAs, notably being less sedative (and lacking the anti-muscarinic component that affects the heart).
Common side effects of these medications include headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation.
Types of SNRIs:
Venlafaxine (Efexor)
Venlafaxine is licensed to treat major depression and generalised anxiety disorder and has some advantages over the older TCAs in so far as it is not sedative and it doesn't have an anti-muscarinic component. It is, however, associated with withdrawal symptoms upon conclusion of treatment.
Duloxetine (Cymbalta)
An SNRI used for major depression and generalised anxiety disorder (and also to treat complications of diabetes and stress urinary incontinence, to satiate curiosity). Whether it is as effective or more effective than TCAs has yet to be established, however it has the advantage of not being sedative or anti-muscarinic.
TCAs
TCA stands for Trycyclic Anti-Drepressant. The trycyclics are an older class of anti-depressant that can be very helpful in treating depression in some people.
Common side effects from these drugs are: a dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and weight gain.
The drowsiness often caused as a side effect with TCAs is exacerbated by consuming alcohol whilst taking TCA medication. Though this may not necessarily be dangerous per se, always ask and follow your doctor's advice regarding consuming alcohol whilst taking TCAs.
Types of TCA:
Amitriptyline (Triptafen, Elavil)
A TCA that is not frequently prescribed; current guidance is that it is not recommended due to its low therapeutic index, and the high mortality associated with an overdose of Amitriptyline, similar to Dosulepin. A common side effect is drowsiness.
Clomipramine (Anafranil)
A standard TCA used for the treatment of depression, Clomipramine is not as dangerous in overdose like some of its counterparts, but still has a low therapeutic index and often causes drowsiness.
Dosulepin/dothiepin (Prothiaden, Prepadine, Dothapax)
TCA that is started at a low dose, and increased if that has no effect. Comes in 25mg capsules and 75mg tablets. Causes drowsness, which is usually incoporated as part of your treatment. (My personal experience [username hidden] with Dosulepin is LOTS of sleep (16hours) for a few nights when the dose is initially increased, but this wears off soonish).
Dosulepin is rarely used due to the high mortality associated with overdose. The theraputic index is low (meaning the theraputic dose is close to the fatal dose). A study reported 95% of deaths from antidepressants in England and Wales between 1993 and 1997 were associated with tricyclic antidepressants, particularly dothiepin (this drug) and amitriptyline (Elavil, Tryptizol, Laroxyl).
Doxepin (Sinequan)
Imipramine (Tofranil)
Lofepramine (Gamanil, Lomont)
This is the TCA least associated with mortality in overdose, and is also less likely than many others to cause drowsiness. It is not recommended in children.
Nortriptyline (Allegron)
Trimipramine (Surmontil)
Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)
Mirtazapine
Mirtazapine is a NaSSA medication. It works in a similar way to the tricyclics, but should have fewer side effects. Mirtazapine is usually perscribed to patients whose bodies resist the main anti depressants such as fluoxetine, setraline etc. It is a strong medication; which is advised to take at night due to the main side effect being that it causes drowsiness. However, it also can make you feel faint, gain weight, have vivid dreams, increase appetite etc.
Patients on this drug predominantly start at a low dosage and like other anti depressants this is increased should it not work. There are rumours that its success rate changes with condition; (for example being low for sufferers of post traumatic stress, however increased results for depression).
MAOIS
MAOIS stands for Monoamine Oxidase Inhibitors. This class of anti-depressant is very rarely used these days, as you have to avoid a number of foods if you are taking one.
Other drugs used to treat depression
A number of other drugs are also used to treat depression. These include flupentixol (an anti-psychotic medication), lithium (for depression associated with bipolar disorder), and a number of other drugs.
Where can I find more information?
A number of organisations produce helpful leaflets about anti depressants. These include:
The MIND guide to making sense of anti-depressants
The Royal College of Psychiatrists Information Sheet: Antidepressants
You should ask your doctor or pharmacist if you have any questions relating to the medication you've been prescribed, and always read the Patient Information sheet!
TSR Users Experiences
Please note that different people have different experiences on the same drug and just because someone had a specific experience that does not mean you would have the same.
Antidepressants
Amitriptyline (Elavil, Endep)
Hellish withdrawal symptoms after 2 months taking it; shivering, headaches, couldn't eat, couldn't sleep. No sufficiently bad effects whilst taking it.
Lithium
made me feel a little zombified and indifferent to everything. Didn't help my mood apart from making me not care about not caring.
Citalopram (Celexa, Cipramil)
Nausea, headaches, slight dizziness wore off after about 10 days. No other effects.
Trembling and nausea for the first two days of taking it, but after that there were no other issues.
Started at 10mg for a few days, then up to 20mg. 40mg after a couple of weeks. Nausea, dizziness for the first few days. No side-effects for a bit, then after a while it made me nocturnal. A while longer and it started giving me crippling headaches, nausea, generally quite unwell until I backed off the dosage from 40mg and eventually stopped it. Unpleasant withdrawal. Never hugely helped me aside from maybe making me marginally less suicidal.
Headaches, nausea, no real effect either.
Didn't really get many noticeable side effects other than a weird metallic taste and very vivid dreams. That said it didn't really help at all even after 6 months of use. Withdrawal wasn't very pleasant as citalopram can cause brain zap headaches.
Worsened my insomnia, gave me headaches and nausea (which, coupled with simply forgetting to eat, led to extreme weight loss and so I was taken off it). Might also have contributed to my increased suicidal thoughts and worsening self-harming. No positive effect on mood, but since I was only on it for six weeks at a fairly low dosage it wasn't really a fair trial.
Duloxetine (Cymbalta)
One of the less bad ones in terms of side effects, nausea, slight dizziness and headache which all wore off relatively quickly.
Started straight at 60mg. Nausea, dizziness, horrible stomach cramps for a couple of days. No side-effects for a while other than maybe feeling a bit more tired. After about a month made me feel almost normal again for a couple of weeks, then pooped out, made me nocturnal. Again got headaches/nausea/fever/generally badness after I'd tried stepping up to 90mg for a while. Also fairly horrible withdrawal, although maybe not as bad as Citalopram.
No initial side effects. No real effect for me. Withdrawl was horrific though. Like having a terrible case of the flu, and the dreaded "brain zaps". Totally wiped me for about two weeks. If you are going to come off, do at least work on a way to ease yourself off with your doctor.
Fluoxetine (Prozac, Sarafem, Symbyax)
Like the worst flu of my life. Aching muscles all over, coldness, headache, dizziness, nausea, seriously seriously horrible experience, I stopped it after 4 days no idea if it would have lasted. Also destroyed any feelings I had, I felt utterly dead inside.
Started on this when I was 14 so used the oral solution to start with (tastes horrible!) No major side effects but I found this did make me rather emotionless.
Wasn't on this for very long at all. I was prescribed this by the second GP I went to about all of this, she prescribed me it to see me through until my appointment with the psychiatrist that she referred me to. It always seemed to give me heartburn when I took it. More seriously though, it aggravated my moods, causing me to get more manic, more often.*
Mirtazapine (Remeron, Avanza, Zispin)
Very sedating on low doses, not so much on higher doses. Also has a tendency to make people very very hungry and hence put on weight. Unlike quetiapine, I found the weight I gained on mirtazapine was from eating stupid amounts rather than it messing my metabolism up or anything like that. Worked well as an antidepressant for a few weeks for me, then quit working entirely.
Makes you very sleepy but this does wear off over time. Also made me very hungry (fun fact - used as an appetite stimulant and anti depressant in cats (my dad is a vet)). Currently on 30mg and no effect yet.
Despite also being an anti-depressant, this worked an awful lot better for me. It caused me to miss about a two months of my 3rd year of college due to the sedation. I also got the constant hunger- as a friend put it 'on this drug, I'd eat that door if there wasn't anything else available!' Over time, both those side effects wore off, but in the end, I stopped taking it because of the nasty overly vivid dreams. Drinking whilst taking Mirtazapine = very cheap nights out
First couple of days on 15mg I felt kinda sedated, didn't get any real oversleeping because of the Reboxetine at the time. No side-effects at all aside from that really. Maybe slight appetite increase, but I've been relatively bored/depressed in general which tends to make me eat more anyway. Quick acting, although positive effects generally tapered down a lot after the first few days (still better than without). Made me sleep a lot (which, what with my insomnia, I welcomed) and gave me vivid dreams. No positive effect on my mood.
Reboxetine (Edronax)
Massive ear pain in one ear, extreme coldness (was wearing so many layers and still freezing cold), dizziness, severe insomnia. The dizziness and ear pain wore off after a little while on it the coldness and insomnia did not.
Sertraline (Zoloft)
Nausea and insomnia, both of which wore off after about 10 days.
Caused significant nausea and killed my appetite causing me to lose a lot of weight, I dropped from 10 stone to 7 and a half stone. Didn't help with depression at all, and probably caused my insomnia to worsen. gave me awful hangover/flu-like symptoms and tachycardia, so I stopped taking it after several days. No effect on mood.
Trazodone (Desyrel)
Very sedating, no other reportable effects.
Venlafaxine (Effexor)
Messed up my sleep a lot - can't remember if it was too much sleep or insomnia though. Didn't have any trouble coming off it despite taking it for several months.
flu-like symptoms, including dizziness and weakness, meaning I could barely get out of bed. Also mental confusion, similar to having a really bad hangover or being extremely sleep-deprived. After a week I saw my GP, who gave me a check up, found my pulse was over 170 bpm and so sent me into hospital overnight (I had a pretty severe and atypical reaction though, and my symptoms all disappeared as soon as I stopped taking the pills). No effect on mood.
Agomelatine(Valdoxan)
Very itchy, was probably allergic to it so discontinued after a few days. Probably helped my sleep a little.
No side-effects whatsoever, gave me a slight lift in mood.
Lofepramine
Started at 70mg. Very dry mouth for the first few days, not so bad after that. Hot flushes kinda when starting up too. After a few days started giving me fairly bad tachycardia, tried cutting down to 35mg but it still gave me issues. Discontinued, no withdrawal syndrome (was only on it for a couple of weeks total).
Reboxetine
Insomnia, weird kinda prickly heat feeling on my back occasionally for the first few days. Insomnia turned into waking up at 4 or 5am which got pretty annoying. Added Mirtazapine to try to sleep better, eventually discontinued Reboxetine as it was only minorly helping. As a solo med it kept me pretty stable and helped concentration a bit anyway. No discontinuation issues.
Lexapro/Escitalopram
Much better than citalopram, no side effects and actually had a decent effect (unfortunately, it stopped working for me after about 6 weeks so I changed)
Depakote (or Sodium Valproate)
When starting felt like a bit of an old man : heartburn, headaches, aches and pains etc. But does wear off. Has definitely reduced my highs.
Carbamazapine (tegretol)
I started this whilst on Mirtazapine. I've not really noticed any major side effects, other than it's a bloody pain when it comes to taking any other drug (most noticably: BC). You're also not meant to drink on it at all, which sucks.
